Case Study # 1
Kathie is a 16 yo, single, white female who has missed four periods. She lives with her grandmother. The grandmother raised her and her two sisters. Kathie is the youngest. One of her sisters has two children. They all live together in a three-bedroom, subsidized apartment. Kathie is five feet six inches, and her current weight is 110 lbs. As far as she can remember, her prepregnant weight was 108. She states that the father of the baby, a 28-year-old married man, denies this is his baby. Kathie states that she is not worried, that he will "come around and love this baby." Kathie attends an overcrowded, inner-city high school and is a junior. She can neither read nor write above the third-grade level. She tells the midwife that when she graduates she wants to become a doctor.
Today's prenatal visit:
Kathie can't believe that she is pregnant since she had been douching for birth control every time she had intercourse. She complains of excessive vomiting and states that she has lost 10 pounds in the past two weeks. Other complaints include intermittent chills, pain in the lower right back area, and pain with voiding. She has dark circles under her eyes, and her mucus membranes are dry and pale. Her vital signs are: BP 108/68, T 103.8 F, P 88, and R 22.
Upon examination, the midwife notes:
1. Right side, cervical lymph glands are enlarged and tender
2. Need dental work on two of her upper right molars
3. Fundal height is three fingers below the umbilicus
4. FHT are heard in the LLQ (130s)
5. When doing her PAP the midwife notes that she has a homogenous gray clinging discharge with a pH of 5.5
6. Urine chemistrip in the office is positive for ketones, nitrites, and leukocytes; negative for glucose and protein
Kathie is given HIV counseling and agrees to be tested. Her HIV test comes back negative.
Answer the following questions:
1. If Kathie's size equals her dates, about how many weeks pregnant do you think she is?
2. Why do you think she put off coming in for prenatal care for so long?
3. How important is it that her due date be established at this first visit?
4. In light of Kathie's advanced gestation and weight loss, how significant is her nausea and vomiting?
5. Which of Kathie's signs and symptoms point to a urinary tract infection?
6. What are the implications of UTI for pregnancy?
7. What are the implications of dental caries/infections for pregnancy?
8. Discuss common misconceptions teens have about contraception.
9. Make a list of topics the nurse should discuss with Kathie as a result of the initial exam.
In light of Kathie's reading level,
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